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Recent advances in hemochromatosis: a 2015 update

A summary of proceedings of the 2014 conference held under the auspices of Hemochromatosis Australia

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Abstract

This review focuses on iron metabolism, the genetics of hemochromatosis, current treatment protocols and various screening methods. Even though the most common form of hereditary hemochromatosis, C282Y gene mutations in the HFE gene, has been extensively studied, novel mutations in both HFE and non-HFE genes have been implicated in this disease. These have important implications for the Asia-Pacific region. In overload, deposition of iron in various body tissues leads to toxic damage. Patients commonly present with non-specific symptoms of malaise and lethargy. Biochemical, imaging and genetic testing can be carried out to confirm diagnosis. Venesection forms the mainstay of treatment and at present cascade screening of affected families is recommended over population-level screening.

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References

  1. Siddique A, Kowdley KV. Review article: the iron overload syndromes. Aliment Pharmacol Ther 2012;35(8):876–893. doi:10.1111/j.1365-2036.2012.05051.x

    Article  CAS  PubMed  Google Scholar 

  2. Zamani F, Bagheri Z, Bayat M, Fereshtehnejad SM, Basi A, Najmabadi H, et al. Iranian hereditary hemochromatosis patients: baseline characteristics, laboratory data and gene mutations. Med Sci Monit Int Med J Exp Clin Res 2012;18(10):CR622–CR629

    CAS  Google Scholar 

  3. Crownover BK, Covey CJ. Hereditary hemochromatosis. Am Fam Phys 2013;87(3):183–190

    Google Scholar 

  4. Kanwar P, Kowdley KV. Metal storage disorders: Wilson disease and hemochromatosis. Med Clin N Am 2014;98(1):87–102. doi:10.1016/j.mcna.2013.09.008

    Article  PubMed  Google Scholar 

  5. Guggenheim KY. Chlorosis: the rise and disappearance of a nutritional disease. J Nutr 1995;125(7):1822–1825

    CAS  PubMed  Google Scholar 

  6. Trousseau A. Glycosurie, diabete sucre. Clinique medicale de l’Hotel-Dieu de Paris 1865;2:663–698

    Google Scholar 

  7. Von Recklinghausen F. Uber haemochromatose. Tageblatt Versammlung Dtsche Naturforscher Arzte Heidelberg 1889;62:324–325

    Google Scholar 

  8. Sheldon JH (1935) Haemochromatosis. Oxford University Press, Humphrey Milford, publisher to the University

  9. Kanwar P, Kowdley KV. Diagnosis and treatment of hereditary hemochromatosis: an update. Exp Rev Gastroenterol Hepatol 2013;7(6):517–530. doi:10.1586/17474124.2013.816114

    Article  CAS  Google Scholar 

  10. Beutler E, Felitti VJ, Koziol JA, Ho NJ, Gelbart T. Penetrance of 845G→A (C282Y) HFE hereditary haemochromatosis mutation in the USA. Lancet 2002;359(9302):211–218. doi:10.1016/S0140-6736(02)07447-0

    Article  PubMed  Google Scholar 

  11. Wood MJ, Skoien R, Powell LW. The global burden of iron overload. Hepatol Int 2009;3(3):434–444. doi:10.1007/s12072-009-9144-z

    Article  PubMed Central  PubMed  Google Scholar 

  12. European Association for the Study of the L. EASL clinical practice guidelines for HFE hemochromatosis. J Hepatol 2010;53(1):3–22. doi:10.1016/j.jhep.2010.03.001

    Article  Google Scholar 

  13. Fenton H. LXXIII.—Oxidation of tartaric acid in presence of iron. J Chem Soc Trans 1894;65:899–910

    Article  CAS  Google Scholar 

  14. Lawen A, Lane DJ. Mammalian iron homeostasis in health and disease: uptake, storage, transport, and molecular mechanisms of action. Antioxid Redox Signal 2013;18(18):2473–2507. doi:10.1089/ars.2011.4271

    Article  CAS  PubMed  Google Scholar 

  15. Haber F, Weiss J. The catalytic decomposition of hydrogen peroxide by iron salts. Proc R Soc Lond Ser A Math Phys Sci 1934;147(861):332–351

    Article  CAS  Google Scholar 

  16. Han O. Molecular mechanism of intestinal iron absorption. Metallomics 2011;3(2):103–109. doi:10.1039/c0mt00043d

    Article  CAS  PubMed  Google Scholar 

  17. Bourdon E, Kang D-K, Ghosh MC, Drake SK, Wey J, Levine RL, et al. The role of endogenous heme synthesis and degradation domain cysteines in cellular iron-dependent degradation of IRP2. Blood Cells Mol Dis 2003;31(2):247–255

    Article  CAS  PubMed  Google Scholar 

  18. Gunshin H, Mackenzie B, Berger UV, Gunshin Y, Romero MF, Boron WF, et al. Cloning and characterization of a mammalian proton-coupled metal-ion transporter. Nature 1997;388(6641):482–488

    Article  CAS  PubMed  Google Scholar 

  19. Greenberg GR, Wintrobe MM. A labile iron pool. J Biol Chem 1946;165(1):397–398

    CAS  PubMed  Google Scholar 

  20. Bartnikas TB. Known and potential roles of transferrin in iron biology. Biometals 2012;25(4):677–686

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Arosio P, Ingrassia R, Cavadini P. Ferritins: a family of molecules for iron storage, antioxidation and more. Biochim et Biophys Acta (BBA) Gen Subj 2009;1790(7):589–599

    Article  CAS  Google Scholar 

  22. Ganz T. Systemic iron homeostasis. Physiol Rev 2013;93(4):1721–1741

    Article  CAS  PubMed  Google Scholar 

  23. Morgan E. Transferrin, biochemistry, physiology and clinical significance. Mol Asp Med 1981;4(1):1–123

    Article  Google Scholar 

  24. Ganz T, Nemeth E. Hepcidin and iron homeostasis. Biochim et Biophys Acta (BBA) Mol Cell Res 2012;1823(9):1434–1443

    Article  CAS  Google Scholar 

  25. McDonald CJ, Wallace DF, Crawford DH, Subramaniam VN. Iron storage disease in Asia-Pacific populations: the importance of non-HFE mutations. J Gastroenterol Hepatol 2013;28(7):1087–1094. doi:10.1111/jgh.12222

    Article  CAS  PubMed  Google Scholar 

  26. Zarrilli F, Elce A, Scorza M, Giordano S, Amato F, Castaldo G. An update on laboratory diagnosis of liver inherited diseases. BioMed Res Int 2013;2013:697940. doi:10.1155/2013/697940

    Article  PubMed Central  PubMed  Google Scholar 

  27. Bassett ML, Hickman PE, Dahlstrom JE. The changing role of liver biopsy in diagnosis and management of haemochromatosis. Pathology 2011;43(5):433–439. doi:10.1097/PAT.0b013e3283490e04

    Article  PubMed  Google Scholar 

  28. Brissot P. Hereditary hemochromatosis. Hematology 2013;18(6):370–371. doi:10.1179/1024533213Z.000000000222

    Article  PubMed  Google Scholar 

  29. Santos PC, Cancado RD, Pereira AC, Schettert IT, Soares RA, Pagliusi RA, et al. Hereditary hemochromatosis: mutations in genes involved in iron homeostasis in Brazilian patients. Blood Cells Mol Dis 2011;46(4):302–307. doi:10.1016/j.bcmd.2011.02.008

    Article  CAS  PubMed  Google Scholar 

  30. Radio FC, Majore S, Binni F, Valiante M, Ricerca BM, De Bernardo C, et al. TFR2-related hereditary hemochromatosis as a frequent cause of primary iron overload in patients from Central-Southern Italy. Blood Cells Mol Dis 2014;52(2):83–87

    Article  CAS  PubMed  Google Scholar 

  31. Fracanzani AL, Piperno A, Valenti L, Fraquelli M, Coletti S, Maraschi A, et al. Hemochromatosis in Italy in the last 30 years: role of genetic and acquired factors. Hepatology 2010;51(2):501–510. doi:10.1002/hep.23333

    Article  CAS  PubMed  Google Scholar 

  32. Pietrangelo A. Hereditary hemochromatosis: pathogenesis, diagnosis, and treatment. Gastroenterology 2010;139(2):393–408. doi:10.1053/j.gastro.2010.06.013 (408 e391–e392)

    Article  PubMed  Google Scholar 

  33. Dongiovanni P, Donati B, Fares R, Lombardi R, Mancina RM, Romeo S, et al. PNPLA3 I148M polymorphism and progressive liver disease. World J Gastroenterol 2013;19(41):6969–6978. doi:10.3748/wjg.v19.i41.6969

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Sood R, Bakashi R, Hegade VS, Kelly SM. Diagnosis and management of hereditary haemochromatosis. Br J Gen Pract 2013;63(611):331–332. doi:10.3399/bjgp13X668410

    Article  PubMed Central  PubMed  Google Scholar 

  35. Sikorska K, Romanowski T, Stalke P, Izycka-Swieszewska E, Bielawski KP. Iron overload and HFE gene mutations in Polish patients with liver cirrhosis. Hepatobiliary Pancreat Dis Int 2011;10(3):270–275

    Article  CAS  PubMed  Google Scholar 

  36. Allen KJ, Gurrin LC, Constantine CC, Osborne NJ, Delatycki MB, Nicoll AJ, et al. Iron-overload-related disease in HFE hereditary hemochromatosis. N Engl J Med 2008;358(3):221–230. doi:10.1056/NEJMoa073286

    Article  CAS  PubMed  Google Scholar 

  37. Powell LW, Dixon JL, Ramm GA, Purdie DM, Lincoln DJ, Anderson GJ, et al. Screening for hemochromatosis in asymptomatic subjects with or without a family history. Arch Intern Med 2006;166(3):294–301

    Article  PubMed  Google Scholar 

  38. Adams PC, Reboussin DM, Barton JC, McLaren CE, Eckfeldt JH, McLaren GD, et al. Hemochromatosis and iron-overload screening in a racially diverse population. N Engl J Med 2005;352(17):1769–1778. doi:10.1056/NEJMoa041534

    Article  CAS  PubMed  Google Scholar 

  39. Castiella A, Zapata E, Otazua P, Zubiaurre L, Fernandez J. Non-HFE–related hemochromatosis: the role of genetic factors. Hepatology 2010;51(4):1473–1474

    Article  CAS  PubMed  Google Scholar 

  40. Camaschella C, Poggiali E. Rare types of genetic hemochromatosis. Acta Haematol 2009;122(2–3):140–145. doi:10.1159/000243798

    Article  CAS  PubMed  Google Scholar 

  41. Bardou-Jacquet E, Cunat S, Beaumont-Epinette MP, Kannengiesser C, Causse X, Sauvion S, et al. Variable age of onset and clinical severity in transferrin receptor 2 related haemochromatosis: novel observations. Br J Haematol 2013;162(2):278–281

    Article  CAS  PubMed  Google Scholar 

  42. Cadet E, Capron D, Perez AS, Crepin SN, Arlot S, Ducroix JP, et al. A targeted approach significantly increases the identification rate of patients with undiagnosed haemochromatosis. J Intern Med 2003;253(2):217–224

    Article  CAS  PubMed  Google Scholar 

  43. Bacon BR, Sadiq SA. Hereditary hemochromatosis: presentation and diagnosis in the 1990s. Am J Gastroenterol 1997;92(5):784–789

    CAS  PubMed  Google Scholar 

  44. Timms AE, Sathananthan R, Bradbury L, Athanasou NA, Wordsworth BP, Brown MA. Genetic testing for haemochromatosis in patients with chondrocalcinosis. Ann Rheum Dis 2002;61(8):745–747

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Swinkels DW, Aalbers N, Elving LD, Bleijenberg G, Swanink CM, van der Meer JW. Primary haemochromatosis: a missed cause of chronic fatigue syndrome? Neth J Med 2002;60(11):429–433

    CAS  PubMed  Google Scholar 

  46. Falize L, Guillygomarc’h A, Perrin M, Laine F, Guyader D, Brissot P, et al. Reversibility of hepatic fibrosis in treated genetic hemochromatosis: a study of 36 cases. Hepatology 2006;44(2):472–477. doi:10.1002/hep.21260

    Article  PubMed  Google Scholar 

  47. Bacon BR, Adams PC, Kowdley KV, Powell LW, Tavill AS, American Association for the Study of Liver D. Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the study of liver diseases. Hepatology 2011;54(1):328–343. doi:10.1002/hep.24330

    Article  PubMed Central  PubMed  Google Scholar 

  48. Olynyk JK, Cullen DJ, Aquilia S, Rossi E, Summerville L, Powell LW. A population-based study of the clinical expression of the hemochromatosis gene. N Engl J Med 1999;341(10):718–724. doi:10.1056/NEJM199909023411002

    Article  CAS  PubMed  Google Scholar 

  49. Adams PC, Agnew S. Alcoholism in hereditary hemochromatosis revisited: prevalence and clinical consequences among homozygous siblings. Hepatology 1996;23(4):724–727. doi:10.1002/hep.510230411

    Article  CAS  PubMed  Google Scholar 

  50. Hutchinson C, Geissler CA, Powell JJ, Bomford A. Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis. Gut 2007;56(9):1291–1295. doi:10.1136/gut.2006.108613

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Morrison ED, Brandhagen DJ, Phatak PD, Barton JC, Krawitt EL, El-Serag HB, et al. Serum ferritin level predicts advanced hepatic fibrosis among US patients with phenotypic hemochromatosis. Ann Intern Med 2003;138(8):627–633

    Article  CAS  PubMed  Google Scholar 

  52. Jehn M, Clark JM, Guallar E. Serum ferritin and risk of the metabolic syndrome in US adults. Diabetes Care 2004;27(10):2422–2428

    Article  PubMed  Google Scholar 

  53. ST Pierre TG, Clark PR, Chua-Anusorn W. Measurement and mapping of liver iron concentrations using magnetic resonance imaging. Ann N Y Acad Sci 2005;1054(1):379–385

    Article  PubMed  Google Scholar 

  54. Harrison SA, Bacon BR. Hereditary hemochromatosis: update for 2003. J Hepatol 2003;38:14–23

  55. Eijkelkamp EJ, Yapp TR, Powell LW. HFE associated hereditary hemochromatosis. Can J Gastroenterol 2000;14:121–125

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Compliance with ethical requirements and Conflict of interest

This article does not contain any studies with human or animal subjects. Dilum Ekanayake, Clinton Roddick and Lawrie Powell have nothing to disclose regarding conflicts of interest.

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Correspondence to Lawrie W. Powell.

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Ekanayake, D., Roddick, C. & Powell, L.W. Recent advances in hemochromatosis: a 2015 update. Hepatol Int 9, 174–182 (2015). https://doi.org/10.1007/s12072-015-9608-2

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